門診病人對藥師用藥指導之需求及現況調查：以國泰綜合醫院內湖分院爲例

The Unmet Needs of Counseling Services: How Far Did We Go?

10.29475/TFMR.200701.0004

陳宥如(Yu-Lu Chen)；杜育儒(Yu-Ju Tu)；張守娟(Shoou-Jiuan Chang)；林惜燕(Hsi-Yen Lin)；林敏雄(Min-Shung Lin)；黃婉翠(Wan-Tsui Huang)

patient counseling ； questionnaire ； ambulatory patients ； patient safety

臺灣家庭醫學研究

5卷1期（2007 / 01 / 01）

35 - 45

繁體中文

優良藥品調劑作業規範(GDP)規定藥事人員交付藥品時，應進行必要之用藥指導。而對病人提供適切的用藥指導，或許可提高病人的服藥配合度及治療成效。本研究之目的為調查門診病人用藥指導的需求和現況，並分析長期用藥及短期用藥的病人之需求差異，將調查結果納入改善或加強病人用藥指導的計劃，來達到以病人為中心的服務目標。本研究對象為國泰綜合醫院內湖分院門診病人，共收集1053位病人。調查工具為自填結構性問卷，問卷內容分為四大部份，包括門診病人的基本資料、就醫經驗、過去用藥指導經驗，以及對藥師用藥指導需求程度。研究中，門診病人實際接受到用藥指導的現況，和病人對藥師用藥指導的需求有明顯的差異，其中有下面四項差異最大：包括藥品與食物之間的交互作用、可能會發生的嚴重副作用、藥品與其它藥品之間的交互作用及藥品的禁忌／注意事項，其差異分別是69.9%、68.4%、67.2%及58.0%。短期用藥及長期用藥病人，在11項對藥師用藥指導需求程度之差異上，以藥品的名稱及忘記服藥處理這兩項無統計顯著差異，而其他9項均有顯著差異。整體來說，9項有統計顯著差異的項目中，短期用藥病人的用藥指導需求皆比長期用藥病人高。在用藥指導型式的差異上，以口頭說明及書面資料這兩項，需求比實際接受的百分比分別降低25.6%及0.4%；但在電腦查詢、實物操作及視訊播放這三項之差距則大幅度提高至12.5%、12.7%及12.1%。藉由調查發現目前藥師實際提供之用藥指導與門診病人之需求有明顯的落差，藥師應加強說明藥品與食物之間的交互作用、可能會發生的嚴重副作用、藥品與其它藥品之間的交互作用及藥品的禁忌／注意事項。應加強對短期用藥病人的用藥教育；並多使用電腦查詢、實物操作及視訊播放等用藥指導的型式。建立病人所需要之用藥指導模式，以確保病人正確使用藥品及自我照顧、提高病人用藥的安全性。

Good Dispensing Practice guidelines in Taiwan requires pharmacists to offer patient counseling when delivering medications to patients. Optimal patient counseling may have the potential to increase patient compliance and clinical outcomes. The purpose of this study is to investigate the patients' need in medication counseling and the current practice of counseling services provided by pharmacists; and to analyze the difference of counseling demand between long-term and short-term medication users. The study was conducted in a branch hospital of a medical center in Northern Taiwan, a total of 1053 ambulatory patients were asked to fill out a questionnaire that included patient's basic demographic information, current medical and medication history, previous counseling experience provided by pharmacists, and requirement about the content of counseling services. Results showed significant differences in four items between the current counseling services and patients' requirement of counseling: drug-food interactions, possible severe adverse drug reactions, drug-drug interactions and contraindications in medication prescribed. Patients taking short-term medications requested more counseling services than those with long-term use, with significant differences in medication dosing instruction, indications, duration, severe adverse drug reactions, contraindications, drug-food interactions, dosage, drug-drug interactions, and storage (p＜0.001). The requests of providing computerized drug information, device-operating skills, and e-learning are roughly 10% more than merely providing verbal consultation and written leaflet. This survey shows a significant discrepancy between the conventional view of professionals and the actual expectations of patients in patient counseling. Narrowing the discrepancy and meeting patients' expectations will improve patients drug compliance and ensure patients' safety.